Provider Demographics
NPI:1093865644
Name:SWANSON, ELIZABETH A (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:SWANSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MEDICAL ARTS ASSOCIATES, LTD.
Mailing Address - Street 2:600 JOHN DEERE ROAD, SUITE 200
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6897
Mailing Address - Country:US
Mailing Address - Phone:309-779-4200
Mailing Address - Fax:309-779-4305
Practice Address - Street 1:MEDICAL ARTS ASSOCIATES, LTD.
Practice Address - Street 2:600 JOHN DEERE ROAD, SUITE 200
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6897
Practice Address - Country:US
Practice Address - Phone:309-779-4200
Practice Address - Fax:309-779-4305
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085001920363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL970030736OtherRR MEDICARE
IL970030736OtherRR MEDICARE
IL204014Medicare ID - Type Unspecified